25 April 2021: Articles
Discontinuation of Hemodialysis After 8 Years in Favor of Toprak’s Kidney Care in a Patient with End-Stage Kidney Disease
Unusual clinical course, Unusual setting of medical care
Omer Toprak A* , Emel A. Bozyel B , Burak Alp B , Ali Kirik ADOI: 10.12659/AJCR.930857
Am J Case Rep 2021; 22:e930857
Table 1. Renal, nutrition, and fluid load parameters and medications of the patient.
| Start of HD | Start of kidney care | HD decreased to 2×/week | HD decreased to 1×/week | HD stopped | HD restarted | HD increased to 3×/week | |
|---|---|---|---|---|---|---|---|
| Date (day/month/year) | 8/7/06 | 9/10/12 | 15/5/13 | 10/6/13 | 9/7/14 | 18/5/15 | 18/3/19 |
| HD, sessions per week/session duration, in hours | 3/4 | 3/4 | 2/4 | 1/4 | 0/0 | 1/4 | 3/4 |
| Weight, kg | 80 | 78 | 77.0 | 77.5 | 76.0 | 76.8 | 76.5 |
| Urine amount, mL/day | 700 | 800 | 1400 | 1700 | 1600 | 1800 | 1300 |
| Blood pressure, mmHg | 160/90 | 110/70 | 120/80 | 140/70 | 110/80 | 140/80 | 110/60 |
| eGFR, mL/min/1.73 m | 5.8 | 11.1 | 12.3 | 12.7 | 14.2 | 5.9 | 6.4 |
| Creatinine, mg/dL | 8.3 | 4.7 | 4.3 | 4.2 | 3.8 | 7.8 | 7.1 |
| Urea, mg/dL | 180 | 130 | 110 | 114 | 102 | 188 | 109 |
| Urine P/C, mg/mg | 155 | 197 | 319 | 2247 | 5344 | 2795 | |
| Blood pH/HCO, mEq/L | 7.28/17 | 7.32/22 | 7.33/22 | 7.38/23 | 7.36/24 | 7.32/19 | 7.31/21 |
| Sodium, mEq/L | 131 | 148 | 141 | 138 | 142 | 144 | 135 |
| Potassium, mEq/L | 5.7 | 5.0 | 4.7 | 4.0 | 4.9 | 4.7 | 4.9 |
| Calcium, mg/dL | 8.2 | 8.9 | 9.5 | 9.5 | 9.8 | 8.7 | 9.8 |
| Phosphorus, mg/dL | 5.0 | 4.1 | 4.1 | 3.5 | 4.1 | 5.7 | 3.8 |
| Magnesium, mg/dL | 2.5 | 2.0 | 2.2 | ||||
| Parathormone, pg/mL | 447.1 | 558.6 | 622.2 | 664.1 | 1187.3 | 374.1 | |
| Hemoglobin, mg/dL | 11.2 | 13.6 | 14.0 | 14.5 | 15.7 | 12.9 | 11.4 |
| Albumin, g/dL | 4.6 | 4.7 | 4.5 | 4.3 | 4.2 | 3.8 | |
| Uric acid, mg/dL | 11.7 | 8.6 | 9.5 | 11.6 | 10.3 | 3.4 | |
| Glucose, mg/dL | 89 | 100 | 107 | 85 | 100 | 100 | 88 |
| Cardiothoracic ratio | 0.49 | 0.48 | 0.48 | 0.49 | 0.49 | 0.55 | |
| Pretibial edema | −/− | −/− | −/− | −/− | −/− | +/+ | |
| Pleural effusion, cm | 0/0 | 0/0 | 0/0 | 0/0 | 0/0 | 3.7/0 | |
| Pericardial effusion, cm | 0 | 0 | 0 | 0 | 0 | ||
| LVEF, % | 60 | 55 | 65 | 60 | 40 | ||
| Calcitriol 0.25 mcg/day | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 |
| Cinacalcet, 30 mg/day | – | – | – | – | – | 1×1 | – |
| Calcium acetate, 700 mg/day | – | 3×1 | 3×1 | 3×1 | 3×1 | 3×1 | 3×1 |
| Acetylsalicylate, 100 mg/day | – | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 |
| Bicarbonate, 100 mg/day | 3×1 | 3×1 | – | – | 3×1 | 3×1 | 3×1 |
| Furosemide 40 mg/day | 1×1 | – | – | – | – | – | 2×1 |
| Carvedilol 12.5 mg/day | – | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 |
| Allopurinol, 150 mg/day | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 | 1×1 | – |
| Warfarin 5 mg/day | – | – | – | – | – | – | 1×1 |
| eGFR – estimated glomerular filtration rate, calculated by CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation; HD – hemodialysis; LVEF – left ventricular ejection fraction; urine P/C – urine protein to creatinine ratio. Renal function test values are those taken before starting dialysis. | |||||||